. 2022 Aug 26:14:1469-1483.

doi: 10.2147/NSS.S368147. eCollection 2022.

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

Brigitte Holzinger^{1

2}, Franziska Nierwetberg¹, Frances Chung³, Courtney J Bolstad⁴, Bjørn Bjorvatn⁵, Ngan Yin Chan⁶, Yves Dauvilliers⁷, Colin A Espie⁸, Fang Han⁹, Yuichi Inoue¹⁰, Damien Leger¹¹, Tainá Macêdo¹², Kentaro Matsui^{13

14}, Ilona Merikanto^{15

16}, Charles M Morin¹⁷, Sérgio A Mota-Rolim¹⁸, Markku Partinen¹⁹, Giuseppe Plazzi^{20

21}, Thomas Penzel²², Mariusz Sieminski²³, Yun Kwok Wing⁶, Serena Scarpelli²⁴, Michael R Nadorff^{4

25}, Luigi De Gennaro^{24

26}

Affiliations

¹ Institute for Consciousness and Dream Research, Vienna, Austria.
² Medical University Vienna, Postgraduate Master ULG Sleep Coaching, Vienna, Austria.
³ Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Mississippi State University, Mississippi State, MS, USA.
⁵ Department of Global Public Health and Primary Care, University of Bergen and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
⁶ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China.
⁷ Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France.
⁸ Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK.
⁹ Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
¹⁰ Tokyo Medical University, Tokyo, Japan.
¹¹ Université de Paris, APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France.
¹² Department of Psychology, Federal University of Rio Grande do Norte, Natal, Brazil.
¹³ Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
¹⁴ Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
¹⁵ SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
¹⁶ Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
¹⁷ École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, QC, Canada.
¹⁸ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital - Federal University of Rio Grande do Norte, Natal, Brazil.
¹⁹ Helsinki Sleep Clinic, Terveystalo Healthcare, and Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
²⁰ IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
²¹ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²² Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
²³ Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
²⁴ Department of Psychology, Sapienza University of Rome, Rome, Italy.
²⁵ Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
²⁶ IRCCS Fondazione Santa Lucia, Rome, Italy.

PMID: 36052103
PMCID: PMC9426865
DOI: 10.2147/NSS.S368147

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

Brigitte Holzinger et al. Nat Sci Sleep. 2022.

. 2022 Aug 26:14:1469-1483.

doi: 10.2147/NSS.S368147. eCollection 2022.

Authors

Affiliations

¹ Institute for Consciousness and Dream Research, Vienna, Austria.
² Medical University Vienna, Postgraduate Master ULG Sleep Coaching, Vienna, Austria.
³ Department of Anesthesiology and Pain Medicine, University Health Network, University of Toronto, Toronto, ON, Canada.
⁴ Mississippi State University, Mississippi State, MS, USA.
⁵ Department of Global Public Health and Primary Care, University of Bergen and Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway.
⁶ Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, Special Administrative Region, People's Republic of China.
⁷ Sleep-Wake Disorders Unit, Department of Neurology, Gui-de-Chauliac Hospital, CHU Montpellier, INM, Univ Montpellier, INSERM, Montpellier, France.
⁸ Sir Jules Thorn Sleep & Circadian Neuroscience Institute (SCNi), University of Oxford, Oxford, UK.
⁹ Department of Pulmonary and Critical Care Medicine, Peking University People's Hospital, Beijing, People's Republic of China.
¹⁰ Tokyo Medical University, Tokyo, Japan.
¹¹ Université de Paris, APHP, Hôtel-Dieu, Centre du Sommeil et de la Vigilance, Paris, France.
¹² Department of Psychology, Federal University of Rio Grande do Norte, Natal, Brazil.
¹³ Department of Laboratory Medicine, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira, Japan.
¹⁴ Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan.
¹⁵ SleepWell Research Program, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
¹⁶ Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland.
¹⁷ École de Psychologie, Centre d'étude des troubles du sommeil, Centre de recherche CERVO/Brain Research Center, Université Laval, Québec, QC, Canada.
¹⁸ Brain Institute, Physiology and Behavior Department, and Onofre Lopes University Hospital - Federal University of Rio Grande do Norte, Natal, Brazil.
¹⁹ Helsinki Sleep Clinic, Terveystalo Healthcare, and Department of Neurosciences, Clinicum, University of Helsinki, Helsinki, Finland.
²⁰ IRCCS, Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy.
²¹ Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy.
²² Sleep Medicine Center, Charité Universitätsmedizin Berlin, Berlin, Germany.
²³ Department of Emergency Medicine, Medical University of Gdansk, Gdansk, Poland.
²⁴ Department of Psychology, Sapienza University of Rome, Rome, Italy.
²⁵ Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.
²⁶ IRCCS Fondazione Santa Lucia, Rome, Italy.

PMID: 36052103
PMCID: PMC9426865
DOI: 10.2147/NSS.S368147

Abstract

Purpose: The COVID-19 pandemic affects mental health and sleep, resulting in frequent nightmares. Therefore, identifying factors associated with nightmare frequency is important, as it can indicate mental health issues. The study aimed to investigate increases in nightmare frequency comparing the pre-pandemic and pandemic period, and identify its risk factors. Further, the mediating role of post-traumatic stress disorder symptoms between the pandemic and nightmares is explored.

Patients and methods: For this cross-sectional survey data were obtained via self-rating online survey (ICOSS: details in Partinen et al, 2021), which was open to anyone older than 18 years. The final volunteer sample consisted of 15,292 participants, divided according to their nightmare frequency (high: ≥1-2 nights/week; low: <1-2 nights/week). A total of 9100 participants were excluded if answers on variables of interest were missing or receiving rewards for participation. Chi-square tests identified changes of nightmare frequency. Predictors of high nightmare frequency were assessed using logistic regression and presented as Odds Ratios. Post-hoc mediation models were used to investigate the role of post-traumatic stress symptoms (PTSS).

Results: The mean age was 41.63 (SD=16.55) with 64.05% females. High nightmare frequency increased significantly from 13.24% to 22.35% during the pandemic. Factors associated with it included self-reported PTSS (OR=2.11), other mental disorders and various sleep disorders or problems. Financial burden due to the pandemic, confinement, having had COVID-19, and work situation during the pandemic were associated with nightmare frequency, those relations were partly mediated through PTSS.

Conclusion: Our results display the pandemic influence on nightmare frequency, which in turn connects to multiple mental health and sleep factors. These relations were partly mediated through PTSS. The COVID-19 pandemic appears to have caused traumatization of a substantial proportion of society. Health care workers should consider nightmares in their screening routines, as it might indicate PTSS and/or other mental and sleep disorders.

Keywords: COVID-19; collective trauma; mental health; nightmares; post-traumatic stress disorder; sleep.

PubMed Disclaimer

Conflict of interest statement

Prof. Dr. Colin A Espie reports personal fees from Big Health (Sleepio), grants from NIHR, outside the submitted work. Dr Kentaro Matsui reports personal fees from Eisai, personal fees from Meiji Seika Pharma, personal fees from Mochida, personal fees from MSD, personal fees from Otsuka Pharmaceutical, personal fees from Takeda Pharmaceutical, personal fees from Yoshitomi Pharmaceutical, outside the submitted work. Prof. Dr. Charles M Morin reports grants from Eisai, Idorsia, Lallemand, personal fees from Eisai, Idorsia, Pear Therapeutics, royalities from Mapi Research Trust, outside the submitted work. Prof. Dr. Markku Partinen reports clinical trials from Bioprojet, Jazz Pharmaceuticals and TEVA, personal fees from GSK and Takeda, personal fees and clinical trials from MSD, outside the submitted work. Prof. Dr. Giuseppe Plazzi reports personal fees from Jazz Pharmaceutical, personal fees from Takeda, personal fees from Idorsia, personal fees from Bioprojet, outside the submitted work. Prof. Dr. Thomas Penzel reports grants from Cidelec, grants from Novartis, grants from Löwenstein Medical, personal fees from Löwenstein Medical, personal fees from Jazz Pharma, personal fees from Neuwirth, consultation to institution from Bayer Healthcare, personal fees from Cerebra, personal fees from National Sleep Foundation, grants from European Union, outside the submitted work; and Shareholder of Advanced Sleep Research, The Siestagroup GmbH, Nukute. Prof. Dr. Yun Kwok Wing reports personal fees from Eisai Co, Ltd (HK), personal fees from Lundbeck HK Ltd, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

**Figure 1**
Mediation models 1, 2, 3, 4.

**Figure 2**
Results of mediation analysis.

See this image and copyright information in PMC

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Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

Affiliations

Has the COVID-19 Pandemic Traumatized Us Collectively? The Impact of the COVID-19 Pandemic on Mental Health and Sleep Factors via Traumatization: A Multinational Survey

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Conflict of interest statement

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